Statins and Diabetes, Reexamined

Statins — the widely prescribed group of cholesterol-lowering drugs that includes atorvastatin (brand name Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor) — have come under scrutiny in recent years for a number of reasons. In 2012, as we noted in a Diabetes Flashpoints post, the US Food and Drug Administration (FDA) added a warning to the label of all statins warning of an increased risk of Type 2 diabetes associated with the drugs. Another post a few weeks later looked at muscle pain and weakness associated with statins, which seem to occur in at least 10% of all people who take them and 25% of those who exercise regularly. Then, in November of last year — as we noted at the time — new medical guidelines were issued that, if followed, would lead to a vast increase in the number of people taking the drugs. Many doctors expressed skepticism about the new guidelines, believing that expanding the population taking them is not warranted, especially given the side effects they can cause.

Now, a new study concludes that the increased risk of diabetes associated with statins, while real, should not stop doctors from prescribing them or patients from taking them. Published last week in the journal Diabetes, Obesity and Metabolism, the study consisted of a review of past studies on both the diabetes-related risks and cardiovascular benefits of statins. According to an article on the study at dailyRx, statins do not uniformly increase the risk of diabetes — in fact, one study from 2001 found that pravastatin (Pravachol) actually reduced the risk of diabetes by 30% among those taking it. Among the typical population taking statins, however — whose risk of developing diabetes is already higher than average — statins do seem to increase the risk of developing Type 2 diabetes. Two high-profile clinical trials, known by their acronyms PROSPER (Prospective Study of Pravastatin in the Elderly at Risk) and JUPITER (Justification for the Use of Statins in Primary Prevention: Intervention Trial Evaluating Rosuvastatin), found that their respective drugs raised the risk of developing diabetes by 32% and 26%. Given that millions of people take statins, numbers like these mean potentially millions of cases of diabetes that would not otherwise occur.

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While “millions of additional diabetes cases” certainly sounds dramatic, the study’s authors — led by David S. H. Bell of the University of Alabama at Birmingham — conclude that many of these newly diagnosed patients would have already had prediabetes. While statins may raise their blood glucose levels enough to lead to a diabetes diagnosis, other drugs can, of course, be taken to lower blood glucose levels, and there is no evidence that statins lead to a higher rate of long-term diabetes complications. Meanwhile, they write, taking statins leads to a 2.6% reduction in cardiovascular events such as heart attack or stroke, according to a clinical trial called EFFECT (Effective Cardiac Treatment). This reduction may seem small, but in practice means that healthy years are added to millions of people’s lives. They also note that according to the JUPITER trial, while participants who had one or more Type 2 diabetes risk factors did experience a higher rate of diabetes after taking the drug, participants without any diabetes risk factors saw no such increase.

How do you feel about statins when it comes to diabetes — are you worried that they raise, or would raise, your blood glucose levels? Are you reassured by findings that they lead to a lower rate of heart attack, stroke, and death from all causes? If you have experienced unpleasant side effects from statins, how did you go about balancing the potential long-term benefits of taking the drug against the problems it caused in the present? Leave a comment below!

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R Liles

Ten years a Type 2 diabetic and just started taking atorvastatin. In the first month, fasting blood sugar readings are up 20% over the previous three months. I also take metformin and glipizide. I am a non-obese diabetic at 160 5’10” who is reasonably active. I was diagnosed with hemochromatosis (iron overload) about 25 years ago. My cholesterol ranges from 180-230 mostly genetic since I haven’t eaten red meat in 30 years, rarely consume dairy, don’t consume poultry except on Thanksgiving but eat fish about once per week. So, I consume very little cholesterol. I’ll probably cease the statin when my supply runs out.

Redneck Angel

I’ve been taking atorvastatin for nearly 20 years. I’ve had diabetes (Type II) for over 40 years. My total cholesterol had slowly inched up past 240 after I turned 40 & the statin brought it down to recommended levels for an “at risk” person. My A1c is under 7.0; most recently it was 6.2 (I’ve always taken insulin). As a retired community health nurse, I am a BIG believer in preventative medicine….

R Liles

R. Liles. High Cholesterol is high cholesterol regardless if its genetic or if its dietary. Not eating red meat means nothing in regards to the content of your LDL cholesterol however as a diabetic you immediately become high risk for heart disease and should be on a statin. Your cholesterol could be much more atherogenic then say somebody who is NOT diabetic. You really should consult with your DR before taking yourself off your statin. The reductions in CV risk have been proven for decades in the diabetic patient population. I would look at you glipizide FIRST. Glipizide or an SFU has a mechanism that never shuts off wether your sugars are in check or not. If your having “creep” in your sugars that could be telling you your SFU is no longer working and its time to move on to a new technology of a med like a DPP4 inhibitor. This med works only when your glucose level is elevated. Like a light switch! Lights only come on when you eat. The SFU light is always on! It never shuts off! It squeezes your pancreas 24-7 and burns up beta cells where a DPP4 could potentially preserve it. Again, speak to your DR about this!

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